Giving Asthmatics Intramuscular Steroids for Preventing Return to the Emergency Department

Giving Asthmatics Intramuscular Steroids for Preventing Return to the Emergency Department: A Randomized Control Trial

This study aims to compare the efficacy of a one-time IM dose of dexamethasone versus a 5-day course of prednisone in adult ED patients presenting with asthma exacerbations. This is a randomized, controlled, double-blind, non-inferiority trial conducted at two urban EDs within the Montefiore Health System.

Asthma exacerbations are a leading cause of emergency department (ED) visits in the United States. In pediatric patients, a single dose of dexamethasone has been widely adopted as an effective and convenient alternative to multi-day oral steroid regimens. However, in adults, evidence regarding the efficacy of a single-dose steroid approach compared to a traditional 5-day course of oral prednisone is mixed. Despite the availability of oral corticosteroids like prednisone, medication adherence after ED discharge remains a significant challenge. Studies indicate that only about 30% of ED patients fill prescribed medications post-discharge. A single-dose intramuscular (IM) dexamethasone regimen offers the advantage of ensuring adequate anti-inflammatory effects for asthma exacerbations. This study aims to compare the efficacy of a one-time IM dose of dexamethasone versus a 5-day course of prednisone in adult ED patients presenting with asthma exacerbations.

Inclusion Criteria:

• Adults ≥18 years old presenting to the ED with an asthma exacerbation
• Diagnosed with asthma per International Classification of Diseases, 10th Revision (ICD-10) criteria or by the treating clinician
• Discharged from the ED with a primary diagnosis of asthma exacerbation
• Initiated systemic corticosteroids during the ED visit
• Must be English or Spanish speaking

Exclusion Criteria:

• Current use of systemic corticosteroids, including Emergency Medical Services (EMS) administration before ED arrival
• History of severe adverse reactions to corticosteroids
• Heart failure and uncontrolled diabetes (glucose >300mg/dL in the ED)
• Pregnancy or breastfeeding as prednisone is the preferred treatment for asthma in this population
• Inability to provide informed consent